Session Objectives

Describe what makes the Integrative and Functional Nutrition

approach unique
Identify the assessment tools for the Integrative and Functional
Nutrition practitioner
Utilize the Integrative and Functional Nutrition approach for clinical
decision making
Offer resources for continuing education

Introduction to
Integrative and
Functional Nutrition

presented by

Sheila Dean, DSc, RDN, LDN, CCN, CDE

Info@IFNAcademy.com

Disclosure
Palm Harbor Center for Health & Healing
www.DrDeanNutrition.com

USF Health Morsani College of Medicine, Adjunct Professor

University of Tampa, Adjunct Professor
Co-Founder of IFN Academy, LLC
www.IFNAcademy.com

Source: N Engl J Medicine 2005; 352:1138

What happens when you try to use the acute care model to
problems that are chronic in nature ?
rush to diagnosis to name the disease
rush to pharmacology
rush to surgery
cut the patient into segments and the patient is not seen in the
wholeness of who they are

A Potential in Life Expectancycontd

The trend in the life expectancy of humans during the past
thousand years has been characterized by a slow, steady
increase.Unless effective population-level interventions to
reduce obesity and chronic disease associated with it are

developed, the steady rise in life expectancy observed in the

modern era may soon come to an end and the youth of today
may, on average, live less healthy and possibly even shorter lives
than their parents.
Source: N Engl J Medicine 2005; 352:1138.

The Results:
Little attention is paid to the patients story beyond the chief
complaint and history of the present illness.
The patients whole story is not understood.
Each complaint becomes a discrete issue, dealt with in isolation
from the others.

Medicine Today
Acute medical care is about:
Crisis management
Must be expeditious
stabilize that patient and lock down physiology to keep
them alive.
Example: myocardial infarction or an asthma attack

Introducing Functional Medicine

The term functional medicine was coined in 1993 by Jeffrey Bland,
PhD to describe the medicine of the future. It is an approach that
embraces:

Patient uniqueness and biochemical individuality

Patient centered
Preventative care
Root cause solutions vs. managing symptoms
Web-like interconnections of physiological factors

Chronic Disease
Chronic illness is 80% of what we see in the medical office.
The nature of chronic disease is multifactorial so that the
intervention has to be multidimensional.
Old approach one molecule for one function for one disease
New approach multiple molecules - multiple functions orchestra of health A systems biology approach

Why systems biology?

What is Functional Medicine?

Why Systems Biology?

Functional Medicine is a personalized, systems-oriented model that

empowers patients and practitioners to achieve the highest
expression of health by working in collaboration to address the
underlying causes of disease.
By shifting the traditional disease-centered focus of medical/nutrition
practice to a more patient-centered approach, Functional Medicine
addresses the whole person, not just an isolated set of symptoms.
Functional Medicine practitioners spend time with their patients,
listening to their histories and looking at the interactions among
genetic, environmental, and lifestyle factors that can influence longterm health and complex, chronic disease. In this way, Functional
Medicine supports the unique expression of health and vitality for
each individual.

Because chronic disease is a food- and lifestyle-driven, environment- and

genetics-influenced phenomenon.
It wont be conquered with drugs and surgery alone.
It can, however, be conquered by integrating what we know about how the
human body works with individualized, patient-centered, science-based care
that addresses the causes of complex, chronic disease, which are rooted in
lifestyle choices, environmental exposures, and genetic influences.
Clinicians must pay much closer attention to etiology; taxonomy alone
naming the diseaseand prescribing drugs or surgery are no longer sufficient
strategies

Diseases/Conditions Related to Poor

Folate Metabolism
Spina bifida and other NTDs
Depression, Anxiety, OCD
Alzheimers
Cognitive Decline
Heart Disease and Stroke
Cancer
High blood pressure
Poor detoxification
Poor energy
Anemia especially macrocytic and
megaloblastic anemia

Defining Integrative Medicine

Integrative medicine is the practice of medicine that reaffirms the
importance of the relationship between practitioner and patient,
focuses on the whole person, is informed by evidence, and makes use
of all appropriate therapeutic approaches, healthcare professionals and
disciplines to achieve optimal health and healing.
-Consortium of Academic Health Centers
for Integrative Medicine, 2009

Integrative and Functional Nutrition

Functional Nutrition

Integrative the integration of multiple modalities of healing and therapies

Personalized approach

Root cause of chronic

disease
Re-establish organ reserve
and vitality
Balance essential core
areas of health
What are those core areas?

Diet/Food/Nutrition
Supplements
Exercise/Yoga
Meditation
TCM/Acupuncture
Massage
Pharmaceuticals

Functional Nutrition focuses on how whole foods and key nutrients

modulates health and the process of healing

http://images.huffingtonpost.com/2013-11-12-functionalmedicinemodel.jpg

Nutrition is cornerstone of FM
Nutrition is prevention oriented
Nutrition is therapeutic
Nutrients and foods are powerful multi-targeted biological response modifiers
Example magnesium, vitamin D, iodine, folate

The Functional Medicine Web:

Complex interactions, multiple access points, diverse effects

Understanding these pathways generates an

approach to treatment that is focused on

the individual
rather than the disease, and on

restoration of health and function,

rather than management of symptoms.

One Size Fits All OUT

Lifestyle Medicine - IN

Insulin Resistance exists on a continuum

Insulin Resistance

2 Key Questions to ask yourself when assessing your patient cases:

Hyperinsulinemia with maintenance of normal

(or near normal) glucose control

What does this person REQUIRE to improve function in order to

support health and healing? (prescriptive diet, supplemental
nutrients, other areas such as restorative sleep, light, love, etc..)
What does this person need to REMOVE to improve function in order
support health and healing? (infection/pathogens, toxins, allergens,
stressinflammation and/or abnormal immune response).

(Compensated Hyperinsulinemia)

Impaired Glucose Tolerance = PreDiabetes

(Uncompensated Hyperinsulinemia)

There is no one diet that is right for every person!

TYPE 2 DIABETES

Health and Disease

A Continuum
HEALTH
fatigue, achy
INSUFFICIENCY
fatigue, pain, migraines, cold, weight gain
PMS and IBS symptoms, FBS 99 mg/dl

DEFICIENCY
TSH, homocysteine, 25 OH D3, HDL
MMA & FIGLU
DISEASE
Source: http://glutensensitivity.net/VojdaniDiagrams.htm#HG

Dx: Hypothyroid, Fibromyalgia, CVD?

Personalized Care &

NCP-ADIME at Center of IFMNT Radial
Key areas connected and influenced
by a persons biochemical and genetic
uniqueness illustrated by the DNA
strands linking key areas
Center of radial depicts food as a
determining factor in health and
disease
Surrounding the radial are
precipitating factors such as food
allergens and intolerances, negative
thoughts and beliefs, pathogens, and
environmental exposures

Why Use the IFMNT Radial?

The IFMNT Radial facilitates the decision-making process
The IFMNT Radial form helps to be thorough, organized and
prioritize information, and also clarifies where further
investigation is needed
The IFMNT Radial will help the RDN to organize the patients
clinical imbalances by underlying causes of disease in a systems
biology Radial framework
Once a comprehensive assessment has been made and initial
laboratory results have been obtained, the integrative and
functional nutritionist develops a treatment plan that focuses on
the areas where the greatest leverage can be foundthose
sections of the radial which appear to have the greatest
concentration of dysfunctions and which are connected to the
most important of the patients signs and symptoms.

What to consider eliminating:

Gluten
Dairy
Corn? Soy? Grains? animal protein?
Refined sugar
Infection
Toxins (alcohol, preservatives, smoking)
Stress management
What to consider adding:
Betaine HCL, broad spectrum digestive enzymes
Probiotics/prebiotics/fermented foods
Glutamine (dose low and go slow)
Omega-3 fish oils
Fiber rich foods
Antioxidant/phytochemical rich foods (i.e. fresh fruits and vegetables, seeds, nuts,
legumes, etc.)

The Integrative and Functional Medical Nutrition Therapy

RADIAL- A Tool for RDNs
From the Integrative and Functional
Medicine Model, the Integrative
Functional Medical Nutrition Therapy
(IFMNT) Radial was established in 2011
by Kathie Swift, MS, RDN, et. al. as a
conceptual framework to assist dietetics
practitioners implementing IFMNT in
practice
It is a model for critical thinking that
embraces both the science and art of
personalized nutrition care with
consideration of multiple conventional or
complementary medicine disciplines
The circular architecture of the IFMNT
Radial allows for the evaluation of
complex interactions and
interrelationships amongst the five key
areas of Integrative and Functional
Medical Nutrition Therapy

Key Areas #1: The Lifestyle Circle

Medical/Multi Symptom
Questionnaire (MSQ)- Toxicity

The Lifestyle Circle takes into

account the many factors that
a nutritionist must consider in
personalizing nutrition care
Assess this area through:
- The Completed Nutrition
Intake
- The Patients Story
antecedents, triggers, etc.
- the RDNs and patient
dialogue
- the Food Frequency
- the Food Journal

- Many MSQs exist

- Rate frequency and
severity of symptoms
- CDC has a Toxic Exposure
History developed with
Agency for Toxic Substances
and Disease Registry

Key Area #3: The Biomarkers Circle

The Biomarkers Circle
biomarkers can have a
considerable impact on diagnostics
and prevention and can facilitate
the development of personalized
nutrition
Assess this area through:
- Anthropometrics wt, bmi, waist
circumference.
- Vitals blood pressure
- Nutrition Focused Physical Exam
- Conventional Lab Data blood,
urine and saliva testing
- Functional Diagnostic Tests

Biomarkers
Digestion/Absorption
Genomics/SNPs
Immune/Inflammatory
Metabolic/Energy
Macronutrients
Micronutrients
Organic Acids
Toxins

Lifestyle
Food/Diet
Culture
Environment
Movement
Nature
Relationships

Sleep
Stress
Spirituality
F Sunlight
Supplements
Traditions

Key Area #2: The Systems/Signs and Symptoms Circle

The Systems Circle represents
each of the body systems
Assess this area through:
- A nutrition-focused physical
exam
- The MSQ
- Other relevent clinical data in
the interview, clinical exam and
overall intake forms and surveys

Systems/Signs
and Symptoms
Nutrition Physical
Symptom Questionnaire
Systems Analysis
Digestive
Endocrine
Immune
Nervous
Reproductive
Detoxification

Some Nutrition Assessment Biomarkers

Key Area #5: Core Imbalances Circle

Functional medicine is anchored
by an examination of the core
clinical imbalances that underlie
various disease conditions
The Core Imbalances Circle Using
this construct, it becomes much
clearer that one disease/condition
may have multiple causes (i.e.,
multiple clinical imbalances), just
as one fundamental imbalance
may be at the root of many
seemingly disparate conditions

Core Imbalances
Cellular Integrity Imbalances
Digestion Imbalances
Detoxification Imbalances
Energy Metabolism Imbalances
Inflammation/Oxidative Stress
Imbalances
Neuro-Endocrine-Immune
Imbalances
Nutritional Status Imbalances

Academy Future-Focused Vision

New Model of Differentiated Practice

Methylation: homocysteine or FIGLU(folic acid), methylmalonic acid (B12 status)

Iron status (transferrin saturation, ferritin, serum iron, total iron binding capacity)
25 OH vitamin D
Comprehensive thyroid panel

TSH
T3, free
T4, free
rT3
Anti-TPO antibodies
Anti-TG antibodies

RBC magnesium
Alkaline phosphatase (Zn status)
CBC- MCV, MCH (folate, B12 status)
Genomics:
MTHFR -methylation
VDR(vitamin D) polymorphisms
GST (Glutathione S-transferase M1,P1,T1)-detoxification
COMT

Key Area #4: The Metabolic Pathways and Network Circle

This area assesses the integrity
of the metabolic networks and
core imbalances that may be
present
Assess this area through:
Reviewing biochemical
assessments can give
information on the functions of
metabolic pathways or networks
when interpreted within the
clinical context in either health
or disease

Metabolic
Pathways
Anabolic/Catabolic
Nutrient Cofactors
Cellular Respiration
Eicosanoid Series
Biotransformation
Steroidogenic Pathway
Urea Cycle

http://integrativerd.org/

Differentiated Entry-Level Practice:

Entry-Level Graduate RDN
Job Settings

Integrative and Functional Medicine

Centers

Differentiated Entry-Level Practice:

Skills for RDN in Integrative/Functional Medicine

Entry-Level Graduate RDN

Applies integrative nutrition

principles to nutrition care and MNT,
including use of nutritional genomics,
dietary supplements and herbal
remedies

The Center for Mind

Body Medicine
Food As Medicine CPE
Program
Topics include:
Core imbalances,
digestive health,
lifestyle medicine,
mindful eating, diet
evolution,
community action,
culinary nutrition

Institute for Functional Medicine

CPE Programs

Integrative and Functional Medicine

Certificate Programs
Integrative and Functional Nutrition Academy CPEUs offered for RDNs, certificate of
training offered as well as the IFNCP credential (www.IFNAcademy.com)
Rutgers School of Related Healthcare Professions certificate in Integrative Health
and Wellness
Kansas University Dietetics and Integrative Medicine Certificate Program
Arizona Center for Integrative Medicine Integrative Lifestyle and Health Certificate

Integrative & Functional Nutrition

Graduate Degree Programs
Bastyr University: MS Nutrition (*Leads to RDN credential,
on campus only)

Live trainings and elearning includes:

GI, Detox, Immune,
Hormone, Cardiometabolic, Methylation,
NFPE, and AFMCP
certification

Saybrook University: MS Integrative and Functional

Nutrition
University of Bridgeport, CT: MS Human Nutrition

Maryland University of Integrative Health: MS Nutrition

and Integrative Health
University of Western States: MS Human Nutrition and
Functional Medicine

KEY POINTS
A Functional Medicine Dietitian.

Takes the time to listen to a patients story

Recognizes that health and disease exist on a continuum
Draws connections between core areas of imbalance and looks for the root cause(s) of
disease
Collaborates with other Integrative and Functional Medicine healthcare providers
Assesses knowledge and seeks additional training as needed

Thank Yous and Acknowledgements

Kathie Madonna Swift, MS, RDN, LDN, FAND, EBQ for generously sharing her
experience and wisdom in integrative and functional nutrition.
MaryBeth Augustine, RDN, CDN, FAND and Kelly Morrow, MS, RDN, CD for
providing sage advice, support and a few beautiful slides for this
presentation.

Diana Noland, MPH, RD, CCN, LD

MaryBeth Augustine, RDN, CDN, FAND

Kathie Madonna Swift, MS, RDN, LDN, FAND

Kelly Morrow, MS, RDN, CD